Effect of Limited Fluid Resuscitation on Intestinal Injury of Hemorrhagic Shock in Rats_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 SHENJing ¹ , WANGPeng-fei ² , WANGBin ³ ,  ZHANGQin ¹ , LIYou-sheng ³

1. Department of General Surgery, The 401 st Hospital of PLA, Qingdao 266071, Shandong Province, China;
2. Department of Intensive Care Unit, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310020, Zhejiang Province, China;
3. Department of General Surgery/Research Institute of General Surgery PLA, General Hospital of Nanjing Military Region, Nanjing 210002, Jiangsu Province, China;

Corresponding author：

ZHANGQin, Email: 15153270303@163.com

Keywords：

Limited fluid resuscitation; Hemorrhagic shock; Intestinal injury; Intestinal permeability

DOI：

10.7507/1007-9424.20140163

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Objective To determine the effects of different volume fluid resuscitation on intestinal injury and the permeability of intestine in hemorrhagic shock rats. Methods Sprague-Dawley male rats(n=72) were randomly equally divided into 4 groups after the model establishment of blood pressure-controlled hemorrhage, 45, 30, and 15 mL/(kg·h) of fluid resuscitation were performed in high dosage of resuscitation(HLR), moderate dosage of resuscitation(MLR), and low dosage of resuscitation(LLR) group respectively, but rats of Sham group didn't accept fluid resuscitation. After resuscitation, ten centimeters ileum was harvested for testing intestinal permeability. Then 6 rats of each group were sacrificed at 24, 48, and 72 hours after fluid resuscitation respectively. Over the specified time interval, blood was collected for testing levels of lactic acid and plasma tumor necrosis factor-α(TNF-α). The ileums of 3 resuscitation groups were obtained for testing the ratio of wet weight to dry weight and observing the histological changes. Results After resuscitation, the intestinal permeability was higher in HLR group(P<0.05). At 3-8 hours after resuscitation, rats of Sham group were all died, and the other rats of 3 groups were all alive. The level of plasma lactic acid was lower in LLR group than those of other 2 groups at 24 hours(P<0.05). The levels of TNF-α were higher in HLR group than those of other 2 groups at 24, 48, and 72 hours(P<0.05), and at 48 hours, level of TNF-α in LLR group was lower than MLR group(P<0.05). At 24 hours after resuscitation, ratio of intestinal wet weight to dry weight in LLR group was the lowest, and HLR group was the highest(P<0.05). According to the histopathology, intestinal injuries of the 3 groups were tend to be remission with the time, and at 48 and 72 hours after resuscitation, intestinal villus of LLR group appeared to be normal. Conclusion Limited fluid resuscitation of 15 mL/(kg·h) could not only decrease the levels of lactic acid and TNF-α, but also moderate the intestinal permeability and the intestinal injury in early stage after shock and surgery.

Citation： SHENJing, WANGPeng-fei, WANGBin, ZHANGQin, LIYou-sheng. Effect of Limited Fluid Resuscitation on Intestinal Injury of Hemorrhagic Shock in Rats. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(6): 676-681. doi: 10.7507/1007-9424.20140163 Copy

1.	Roppolo LP, Wigginton JG, Pepe PE.Intravenous fluid resuscitation for the trauma patient[J].Curr Opin Crit Care, 2010, 16(4):283-288.
2.	Akech S, Ledermann H, Maitland K.Choice of fluids for resuscitation in children with severe infection and shock:systematic review[J].BMJ, 2010, 341:c4416.
3.	Hammond TN, Holm JL.Limited fluid volume resuscitation[J].Compend Contin Educ Vet, 2009, 31(7):309-320.
4.	Mainous MR, Ertel W, Chaudry IH, et al.The gut:a cytokinegenerating organ in systemic inflammation?[J].Shock, 1995, 4(3):193-199.
5.	Silva AE, do Nascimento P Jr, Beier SL, et al.Gastric mucosal perfusion in dogs:effects of halogenated anesthetics and of hemorrhage[J].J Invest Surg, 2008, 21(1):15-23.
6.	Bajardi G, Pecoraro F, Mirabella D, et al.Abdominal compartment syndrome (ACS) after abdominal aortic aneurysm (AAA) open repair[J].Ann Ital Chir, 2009, 80(5):369-374.
7.	赵中江,孙冀武,邓哲.不同方式液体复苏对失血性休克大鼠外周血单个核细胞中核转录因子-κB活性的影响[J].中国危重病急救医学, 2007, 19(5):299-302.
8.	戴朝六.外科围手术期病人胶体液与晶体液补充原则[J].中国实用外科杂志, 2007, 27(8):602-604.
9.	Kowalenko T, Stern S, Dronen S, et al.Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic hock in a swine model[J].J Trauma, 1992, 33(3):349-353.
10.	Bickell WH, Bruttig SP, Millnamow GA, et al.Use of hypertonic saline/dextran versus lactated ringer's solution as a resuscitation fluid after uncontrolled aortic hemorrhage in anesthetized swine[J].Ann Emerg Med, 1992, 21(9):1077-1085.
11.	Owens TM, Watson WC, Prough DS, et al.Limiting initial resuscitation of uncontrolled hemorrhage reduces internal bleeding and subsequent volume requirements[J].J Trauma, 1995, 39(2):200-207.
12.	Rotondo MF, Schwab CW, McGonigal MD, et al.‘Damage control’:an approach for improved survival in exsanguinating penetrating abdominal injury[J].J Trauma, 1993, 35(3):375-382.
13.	de Guzman E, Shankar MN, Mattox KL.Limited volume resuscitation in penetrating thoracoabdominal trauma[J].AACN Clin Issues, 1999, 10(1):61-68.
14.	Rivers EP, Jaehne AK, Eichhorn-Wharry L, et al.Fluid therapy in septic shock[J].Curr Opin Crit Care, 2010, 16(4):297-308.
15.	Asehnoune K, Fitting C, Edouard AR, et al.Influence of resuscitation volume on blood cells TNF production in a murine model of haemorrhage[J].Resuscitation, 2006, 68(1):127-133.
16.	Wattanasirichaigoon S, Menconi MJ, Delude RL, et al.Effect of mesenteric ischemia and reperfusion or hemorrhagic shock on intestinal mucosal permeability and ATP content in rats[J].Shock, 1999, 12(2):127-133.
17.	Tian J, Lin X, Guan R, et al.The effects of hydroxyethyl starch on lung capillary permeability in endotoxic rats and possible mechanisms[J].Anesth Analg, 2004, 98(3):768-774.
18.	Chiu CJ, Mcardle AH, Brown R, et al.Intestinal mucosal lesion in low-flow states.Ⅰ.A morphological, hemodynamic, and metabolic reappraisal[J].Arch Surg, 1970, 101(4):478-483.
19.	Pepe PE, Dutton RP, Fowler RL.Preoperative resuscitation of the trauma patient[J].Curr Opin Anaesthesiol, 2008, 21(2):216-221.
20.	Russell DH, Barreto JC, Klemm K, et al.Hemorrhagic shock increases gut macromolecular permeability in the rat[J].Shock, 1995, 4(1):50-55.
21.	Deb S, Sun L, Martin B, et al.Lactated ringer's solution and hetastarch but not plasma resuscitation after rat hemorrhagic shock is associated with immediate lung apoptosis by the up-regulation of the Bax protein[J].J Trauma, 2000, 49(1):47-53.
22.	Taniguchi T, Koido Y, Aiboshi J, et al.The ratio of interleukin-6 to interleukin-10 correlates with severity in patients with chest and abdominal trauma[J].Am J Emerg Med, 1999, 17(6):548-551.
23.	Sato H, Kasai K, Tanaka T, et al.Role of tumor necrosis factor-α and interleukin-1b on lung dysfunction following hemorrhagic shock in rats[J].Med Sci Monit, 2008, 14(5):BR79-BR87.
24.	Ho AM, Karmakar MK, Contardi LH, et al.Excessive use of normal saline in managing traumatized patients in shock:a preventable contributor to acidosis[J].J Trauma, 2001, 51(1):173-177.
25.	Gurfinkel V, Poggetti RS, Fontes B, et al.Hypertonic saline improves tissue oxygenation and reduces systemic and pulmonary inflammatory response caused by hemorrhagic shock[J].J Trauma, 2003, 54(6):1137-1145.
26.	Kelly ME, Miller PR, Greenhaw JJ, et al.Novel resuscitation strategy for pulmonary contusion after severe chest trauma[J].J Trauma, 2003, 55(1):94-105.
27.	Köylüoglu G, Bakici MZ, Elagöz S, et al.The effects of pentoxifylline treatment on bacterial translocation after hemorrhagic shock in rats[J].Clin Exp Med, 2001, 1(1):61-66.
28.	Haizlip TM Jr, Poole GV, Falzon AL.Initial resuscitation volume in uncontrolled hemorrhage:effects on organ function[J].Am Surg, 1999, 65(3):215-217.
29.	Menconi MJ, Salzman AL, Unno N, et al.Acidosis induces hyperpermeability in Caco-2BBe cultured intestinal epithelial monolayers[J].Am J Physiol, 1997, 272(5 Pt 1):G1007-G1021.

1. Roppolo LP, Wigginton JG, Pepe PE.Intravenous fluid resuscitation for the trauma patient[J].Curr Opin Crit Care, 2010, 16(4):283-288.
2. Akech S, Ledermann H, Maitland K.Choice of fluids for resuscitation in children with severe infection and shock:systematic review[J].BMJ, 2010, 341:c4416.
3. Hammond TN, Holm JL.Limited fluid volume resuscitation[J].Compend Contin Educ Vet, 2009, 31(7):309-320.
4. Mainous MR, Ertel W, Chaudry IH, et al.The gut:a cytokinegenerating organ in systemic inflammation?[J].Shock, 1995, 4(3):193-199.
5. Silva AE, do Nascimento P Jr, Beier SL, et al.Gastric mucosal perfusion in dogs:effects of halogenated anesthetics and of hemorrhage[J].J Invest Surg, 2008, 21(1):15-23.
6. Bajardi G, Pecoraro F, Mirabella D, et al.Abdominal compartment syndrome (ACS) after abdominal aortic aneurysm (AAA) open repair[J].Ann Ital Chir, 2009, 80(5):369-374.
7. 赵中江,孙冀武,邓哲.不同方式液体复苏对失血性休克大鼠外周血单个核细胞中核转录因子-κB活性的影响[J].中国危重病急救医学, 2007, 19(5):299-302.
8. 戴朝六.外科围手术期病人胶体液与晶体液补充原则[J].中国实用外科杂志, 2007, 27(8):602-604.
9. Kowalenko T, Stern S, Dronen S, et al.Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic hock in a swine model[J].J Trauma, 1992, 33(3):349-353.
10. Bickell WH, Bruttig SP, Millnamow GA, et al.Use of hypertonic saline/dextran versus lactated ringer's solution as a resuscitation fluid after uncontrolled aortic hemorrhage in anesthetized swine[J].Ann Emerg Med, 1992, 21(9):1077-1085.
11. Owens TM, Watson WC, Prough DS, et al.Limiting initial resuscitation of uncontrolled hemorrhage reduces internal bleeding and subsequent volume requirements[J].J Trauma, 1995, 39(2):200-207.
12. Rotondo MF, Schwab CW, McGonigal MD, et al.‘Damage control’:an approach for improved survival in exsanguinating penetrating abdominal injury[J].J Trauma, 1993, 35(3):375-382.
13. de Guzman E, Shankar MN, Mattox KL.Limited volume resuscitation in penetrating thoracoabdominal trauma[J].AACN Clin Issues, 1999, 10(1):61-68.
14. Rivers EP, Jaehne AK, Eichhorn-Wharry L, et al.Fluid therapy in septic shock[J].Curr Opin Crit Care, 2010, 16(4):297-308.
15. Asehnoune K, Fitting C, Edouard AR, et al.Influence of resuscitation volume on blood cells TNF production in a murine model of haemorrhage[J].Resuscitation, 2006, 68(1):127-133.
16. Wattanasirichaigoon S, Menconi MJ, Delude RL, et al.Effect of mesenteric ischemia and reperfusion or hemorrhagic shock on intestinal mucosal permeability and ATP content in rats[J].Shock, 1999, 12(2):127-133.
17. Tian J, Lin X, Guan R, et al.The effects of hydroxyethyl starch on lung capillary permeability in endotoxic rats and possible mechanisms[J].Anesth Analg, 2004, 98(3):768-774.
18. Chiu CJ, Mcardle AH, Brown R, et al.Intestinal mucosal lesion in low-flow states.Ⅰ.A morphological, hemodynamic, and metabolic reappraisal[J].Arch Surg, 1970, 101(4):478-483.
19. Pepe PE, Dutton RP, Fowler RL.Preoperative resuscitation of the trauma patient[J].Curr Opin Anaesthesiol, 2008, 21(2):216-221.
20. Russell DH, Barreto JC, Klemm K, et al.Hemorrhagic shock increases gut macromolecular permeability in the rat[J].Shock, 1995, 4(1):50-55.
21. Deb S, Sun L, Martin B, et al.Lactated ringer's solution and hetastarch but not plasma resuscitation after rat hemorrhagic shock is associated with immediate lung apoptosis by the up-regulation of the Bax protein[J].J Trauma, 2000, 49(1):47-53.
22. Taniguchi T, Koido Y, Aiboshi J, et al.The ratio of interleukin-6 to interleukin-10 correlates with severity in patients with chest and abdominal trauma[J].Am J Emerg Med, 1999, 17(6):548-551.
23. Sato H, Kasai K, Tanaka T, et al.Role of tumor necrosis factor-α and interleukin-1b on lung dysfunction following hemorrhagic shock in rats[J].Med Sci Monit, 2008, 14(5):BR79-BR87.
24. Ho AM, Karmakar MK, Contardi LH, et al.Excessive use of normal saline in managing traumatized patients in shock:a preventable contributor to acidosis[J].J Trauma, 2001, 51(1):173-177.
25. Gurfinkel V, Poggetti RS, Fontes B, et al.Hypertonic saline improves tissue oxygenation and reduces systemic and pulmonary inflammatory response caused by hemorrhagic shock[J].J Trauma, 2003, 54(6):1137-1145.
26. Kelly ME, Miller PR, Greenhaw JJ, et al.Novel resuscitation strategy for pulmonary contusion after severe chest trauma[J].J Trauma, 2003, 55(1):94-105.
27. Köylüoglu G, Bakici MZ, Elagöz S, et al.The effects of pentoxifylline treatment on bacterial translocation after hemorrhagic shock in rats[J].Clin Exp Med, 2001, 1(1):61-66.
28. Haizlip TM Jr, Poole GV, Falzon AL.Initial resuscitation volume in uncontrolled hemorrhage:effects on organ function[J].Am Surg, 1999, 65(3):215-217.
29. Menconi MJ, Salzman AL, Unno N, et al.Acidosis induces hyperpermeability in Caco-2BBe cultured intestinal epithelial monolayers[J].Am J Physiol, 1997, 272(5 Pt 1):G1007-G1021.

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Effect of Limited Fluid Resuscitation on Intestinal Injury of Hemorrhagic Shock in Rats

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